Saturday, September 7, 2013

ObamaCare is Working?

Since I don't know much about the Patient Protection and Affordable Care Act, I am pretty indifferent to it.  However it seems that the Left are Praising it and the Right are Vilifying it...  So it should make for a good research topic, when I get time this weekend between outdoor activities.

I do have one piece of knowledge that has been confirmed by the HR groups of both the companies that I have worked with during the past year.  The premiums that my company and I pay for family coverage have gone up because of PPACA.  This makes perfect sense because the "benefits" my family may receive and the "risk" that the insurance company faces have increased.  Three of the key factors as I understand them are: kids are covered longer, certain benefits are mandatory and applicants with pre-existing conditions can not be denied or charged a higher rate.  Makes sense.

Here are Liberal links that praise the PPACA:
MPP Obamacare Doing What It is Supposed To (Joe Bodell)
MPP Obamacare is Working (Dog Gone)
MPP MN Sure Rates (Big E)

Here are Conservative links that critique PPACA:
Heritage Foundation:Obamacare

Here are a mix of links:
ObamaCare Facts
AARP: Fact Sheets
Kaiser Family Foundation
Policy Mic: Pros/Cons
Huff Post Obamacare
Bloomberg Cost Affordable
Wash Post Know premiums.  Affordable?
Wash Post Health care
Just the Facts: Healthcare
The Economist Rate Shock?

This post(s) will be developing all weekend.  So what links should I add and study?

A secondary goal is to determine if Liberal and Conservative links are factual or not?
(A side discussion Dog, J and I are working.. Dog says Conservatives make stuff up and J says Liberals make stuff up...)


Laurie said...

Here is a link for your research:

Kaiser Family Foundation

It seems that premiums have gone up 4% in 2013. Not much to complain about. I don't know how inflation is figured in to this.

John said...

I actually printed out their 29 page report before going boating. Now I am going to crack open a beer and do some light reading.

I am interested to see how they came up with the 4%, my increase was more and with many companies dropping spousal coverage I am surprised it was that low.

Just a reminder, 4% would be good however it is higher than the CPI and likely most of our raises. Thanks for the reminder to add the link.

Anyone else have any links / references we should consider to get the real facts?

jerrye92002 said...

Some states are reporting increases of 40-70-150%. I can't readily find the cite. I would like to challenge you to take a different tack: that is, explain logically how it can possibly work as promised? That promise, remember, was that we could give millions more people health care, of better quality and at lower cost, without adding a single doctor?

John said...

Interesting quotes from Wiki:

"An individual mandate requires all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs (such as Tricare), to secure an approved private-insurance policy or pay a penalty, unless the applicable individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship."

Which answers one of my questions. Apparently Medicaid will continue as is, so no cost / tax reductions here. Any disagreement with this FACT?

"Low-income individuals and families above 100% and up to 400% of the federal poverty level will receive federal subsidies on a sliding scale if they choose to purchase insurance via an exchange. Those from 133% to 150% of the poverty level will be subsidized such that their premium costs will be 3% to 4% of income. In 2013, the subsidy would apply for incomes up to $45,960 for an individual or $94,200 for a family of four; consumers can choose to receive their tax credits in advance, and the exchange will send the money directly to the insurer every month."

FACT 2: The government / tax payers will be paying a significant portion of the health insurance premiums for low income households that do not have employers contributing to their healthcare premium payments. This money will come from taxes on businesses and personal income. (ie people who pay Federal taxes) Any disagreement with this FACT?

John said...

Personally I don't care what anyone promised. When that method is pursued we quickly enter the "he said she said" spiral of death... Wife and 3 daughters, been there too many times...

My life is about pros/cons, and I always list both.. What pros do you see regarding Obamacare? Or are you so biased that you can not see them?

I would think eliminating the "pre-existing condition" trap for millions of families could be consider a Pro by most compassionate humans, or those who are worried they may land in it.

Laurie said...

It was my impression that Obamacare was not going to increase my income taxes. That whatever I pay toward subsidizing health insurance for others was more indirect. I guess I don't agree completely with fact 2.

John said...

Good catch Laurie. I was just assuming it was coming out of the general fund. I will need to confirm the funding source. However this may be why the "defunding" argument is so lively in Congress..

One correction to Dog's post. "And that is why conservatives hate it – they could have implemented it, but they didn’t."

I think given the large subsidy (gift) discussed here, no Conservative wishes they had implemented this. I mean it sounds like we tax payers will be paying for the health insurance of a lot of people. (for better or worse)

Remember this is an income tax credit. Meaning more people will either pay no income taxes, or they will be getting a big refund check back for taxes they did not with hold for.

I guess I may be correct, there will be less taxes paid into the general fund, so that money will need to be made up from somewhere else. (to be determined)

Any disagreements with this logic.

jerrye92002 said...

I can see the pros, but they are SO minute compared to the cons that they almost escape notice. I observe that some Obamacare opponents want to keep, though radically reform, the Obamacare exchanges. The idea of a central place to buy health insurance maintains competition while easing the burden of "shopping" and that's a good thing. Everything else about the exchanges is wrong, of course, including the fact that MN government has already spent $130 million to set one up and hasn't sold a single policy.

Pre-existing condition coverage is not a benefit, it's simply a fallacy promoted to an ideal. It is not possible to "INSURE" somebody with a pre-existing condition because there is a 100% certainty that the insurer will lose money, without a pool of people who are NOT sick to cover the expense. Unless, of course, we raise the premiums on you to equal what we know you will cost us, in which case you are better off just paying for your own care. That's unfortunate for you (or we could have some charity pick up the tab, or we could create a "high risk pool"-- many already exist in the free market-- for insurers to charge very high but rational prices). Obamacare makes it worse by mandating that these people get coverage regardless, so in effect nobody will buy insurance until they get sick, and the insurance companies will then charge a premium based on the fact that everybody in their risk pool is 100% certain to cost them money. In effect, then, we ALL pay the FULL cost of care.

Come to think about it, Those are the fundamental logical fallacies of Obamacare, aren't they? First, it equates having health INSURANCE with having health CARE and that's simply not the case, especially if you try to tell doctors what they will be paid and how they must treat their patients. You will see (and are already seeing) LESS total health care available as doctors leave the profession. Second, there is the belief that we can draw OUT more health care dollars [to pay for care] from the health insurance system than we put IN in premiums (+tax dollars), and that, too, is pure fantasy.

In short, it is simply IMPOSSIBLE for Obamacare to work, and you cannot possibly prove that it does, or will. It has already made "the system" worse for millions, including me.

jerrye92002 said...

"It was my impression that Obamacare was not going to increase my income taxes." -- Laurie

Laurie, that's what we were all told, but we know it was a lie. The CBO now says that cost estimates have TRIPLED over what was promised in the original legislation, and among the "offsets" of that original cost were the employer mandate, now postponed by Obama, a delay in the "fines" mechanism of the individual mandate, and a $700 billion cut to Medicare that means less medical care available to seniors. In other words, pretty much all of the new revenue is gone, and the costs that were supposed to go down have clearly gone up. "If you like your health care plan you can keep it" was another BIG (and unforgivable, IMHO)lie.

But, taxes don't have to go up, we can continue to put this humongous charge on our kids' credit cards.

jerrye92002 said...

John, Medicaid will continue as is, except that Obamacare mandates that more people be eligible and that the cost of each "insured" must increase, so states are going to go broke funding it. The program should have been burned and buried rather than given a jolt of lightning.

John said...

J, This a factual review. Sources, sources, sources...

jerrye92002 said...

Sources? How about the dictionary definition of "insurance"? Covering people with pre-existing conditions does not qualify. Do you need a source for the kindergarten math that says you cannot get more money out of a program than you put into it? Do you want a source for people losing their health plan that they liked, because I can attest to that personally, or are you looking for Obama's promise that we could keep it?

If the promises made about legislation turn out to be lies, or "non-facts" if you prefer, isn't that proof that the legislation is "non-working"?

John said...

I understand your frustration, I have been affected also. However statements without backup material support Dog's views that Conservatives speak beliefs rather than facts.

I am torn on "insurance" and "pre-existing conditions"? You are correct that the insurance company knows they will likely need to pay something due to the pre-existing condition. However they know that with almost every new client they will need to pay something.

What they don't ever know is exactly how big the payout will be. However you are correct that they will need to raise premiums as these likely more expensive clients enter the pool.

G2A Pre-Existing Condition Fraud

jerrye92002 said...

Here is a brief list, with cites.

Too bad Heritage didn't have more space for a full catalog of the failures.

Another authority:

All of these things are well known to anybody paying attention. It isn't so much that we challenge Dog on his "facts" but that we question his grasp of reality, his common sense and his access to common knowledge.

jerrye92002 said...

"What they don't ever know is exactly how big the payout will be."

And that is the only reason that high-risk insurance pools exist. Get enough pre-existing condition folks together, charge them a rational amount based on their actual condition, and you can actual come out offering those policies. Obamacare prohibits that.

Actually, a more common way pre-existing conditions are handled by insurance companies, assuming the condition isn't imminently and greatly expensive, is to simply write in an "exclusion" of 6-12 months, or a permanent exclusion for expenses from that condition. Then folks get a more or less normal insurance policy at a more or less normal price. Obamacare prohibits that.

jerrye92002 said...

Here's the authority on the central question. Q: will insurance rates go down under Obamacare as promised? ($2500 per family). A: No, they go up by 24%, on average.

Sean said...

As for the subsidies, we're already subsidizing health care. All of that emergency room care for folks without insurance and the ability to pay is being paid for -- either through taxes or higher prices on our other medical services. What the individual mandate does is give everybody some skin in the game, whether it's by buying a policy or paying the tax penalty.

Additionally, Jerry spreads some bogus notions, like the CBO says costs have doubled or tripled. Not true (the cost increase is n illusion created by replacing 2010 and 2011 with 2021 and 2022), see:

Or that the cuts to Medicare will reduce care for seniors. Not true (the cuts merely remove the subsidy to private insurance plans that don't cover seniors more cheaply than Medicare itself), see:

jerrye92002 said...

Thanks for the links.

By all means, let us get our "facts" straight, but let's make sure we have the context as well.

Yes, we now "pay for" some very expensive ER care for the uninsured, but that simply proves what I said about health insurance not being equal to health care-- a fundamental fallacy of Obamacare. Give these people health insurance and we all still pay (they will be subsidized) and there will not be one additional doctor to give them that care. So all of those "48 million uninsured" (some 30 million or so will REMAIN uninsured under Obamacare) are getting care already, and Obamacare isn't helping, at best. Those who are now freeloading at the ER but could afford some "skin in the game" (I choose to believe there aren't that many) will find it easier to pay the fine than to buy the insurance, and STILL go to the ER for their care!

And what's being overlooked is why we have this problem in the first place. It's because of a federal law requiring that these folks get ER treatment regardless of ability (or willingness) to pay, coupled with federal and state regulations that price simple health insurance out of the reach of low-income folks. If we went back to the old system where folks could get treated in the ER without insurance but would be billed and billed until they paid something, they would stop doing it except for emergencies, and if insurance was available at a free-market price they might be prompted to go get it. In short, Obamacare just gives us more of the government marketplace distortion that got us in this mess in the first place.

As for costs, yes, you are correct. The Obamacare costs that have double or tripled are not the 1-year budget numbers, but the 10-year budget numbers from CBO. But both the previous number and the current number are 10-year projections, just different years, and the latest one does not include the "10 years of taxes and six years of benefits" distortion of the earlier number. The other thing worthy of note is that these are projections. The actual cost of Medicare has increased something like 70-fold over the projections made for it when it was passed. Obamacare may be little better, except that there isn't enough money in the world for that to happen.

The "cuts to Medicare" argument is one of those where the facts differ depending on which way you look at it and who is doing the looking. Medicare advantage is a popular Medicare SUPPLEMENT, paid out of premiums just as all other supplemental insurance plans are, but with a subsidy from government. Seniors NEED a supplement because Medicare only pays doctors about 1/3 of their going rates, and many already refuse to see new Medicare-only patients (i.e. without supplements). The article goes on to point out this may get worse under Obamacare. The worst part of this is that the 25% of seniors who LIKE MA will not be allowed to keep it, breaking Obama's promise millions of times over. No surprise here, unfortunately. Again, if a program fails to keep the promises made for it, how can we say it is "working"?

John said...

For your convenience.

Heritage 10 Ways OC Is Not Working

IHCC OC Struggles

NR Costs Did Not Double

Swampland Fact Check OC Medicare Cuts

John said...

I am tired so I'll save the research for another day.

However, as I mentioned to the MPP folks. If some of these costs are planned to disappear? (ie HCMC ER costs) Then let's publish a plan to start cutting that money out of the State and Federal budgets as we ramp up the tax credits...

I am not sure if I mentioned this fact yet, but Medicaid recipients are not part of the individual mandate. So Medicaid costs are going no where.

The simple reality is that the tax payers will be paying the "employer's share" of the premium for people who are not employed by company's that are required to pay that portion.

This may have an interesting impact on employment. Maybe companies will be even more tempted to hire contract employees from real small firms. I mean they could possibly let the US Tax payers pay the health insurance subsidy and save more money.

jerrye92002 said...

John, I think you are wrong about Medicaid, and no, I don't have a handy citation for the fact. But Obamacare adds new requirements to Medicaid that will greatly increase costs to the states. It's another of those "hidden costs" of Obamacare not counted in the federal budget explosion we've already noted, like the employer mandate and the individual mandate (declared "taxes" by the SCOTUS).

And can we count as a FACT that, among all the other costs, millions of people are losing their employer-paid insurance or having their hours cut back to avoid Obamacare? I mean, it's all over the news, and if you can't trust the news to be factual... :-/

Sean said...

Sure, some of these costs will go away. We should expect some decline in ER visits, as is starting to be seen under Romneycare.

Yes, you could argue we're paying the employer's portion under the ACA. Even so, the ACA represents two significant changes. First, everyone is paying in to the system in some form. Second, those who choose to buy a subsidized policy instead of paying the penalty open themselves up to using non-emergency care for treatment of routine conditions. This is a more efficient use of health care dollars and it enables people to more easily get conditions treated before they become worse and more expensive to treat.

Jerry is incorrect in his description of Medicare Advantage. Medicare Advantage IS NOT a supplement. Rather, the federal government has contracted with private companies to provide Part A and Part B benefits for retirees who prefer that option. The problem, though, is that arrangement has proven not to provide the cost savings anticipated. In fact, the federal government spends about 12% more on Medicare Advantage enrollees than folks in regular Medicare. The ACA, then, rolls back reimbursement rates to those insurers such that we will no longer be paying more to have these folks out of traditional Medicare. So, yes, it's true that some insurers will likely end their MA programs. But if they can't provide savings over Medicare, why should we pay for it?

Agreed that we don't know for certain what the impact on employment will be. Much has been made about increases in part-time work or removing spouses for coverage, but those trends have been going on for a long time.

John said...

ER Down

Medicare Advantage

Wiki Medicare Advantage

Defending Indefensible

John said...

Obamacare Facts Medicaid Expansion
Heritage Medicaid Expansion
WP Medicaid Expansion

jerrye92002 said...

"Medicare Advantage IS NOT a supplement."

Part of the problem is semantics. The fact is that, if you opt for MA, you are NOT permitted to purchase a "Medigap" (aka supplemental) policy, and that MA offers benefits ABOVE what Medicare provides, usually including drug coverage (extra under Medicare) as well. Naturally this extra coverage can be expected to cost more; no surprise. But the other question is logical. If all MA did was offer standard Part A and B but through private insurers, why would 25% of Medicare recipients choose it? And why would Obama promise that those who had chosen it could keep it, if Obamacare cuts them off from it?

Sean said...

Yes, it's true that the MA also acts as a supplement. The federal government, though, only pays for the Part A and Part B part of it, though. And private insurers are delivering no savings on this, so what's the point in paying for it? Which is why the Ryan budget framework House Republicans have voted in favor of the last few years has the exact same provision.

jerrye92002 said...

"The federal government, though, only pays for the Part A and Part B part of it, though. And private insurers are delivering no savings on this,..."

Exactly right-- Medicare beneficiaries are choosing to buy their "supplemental" through the government but with private insurers. The amount paid by both government and the insured for the Parts A and B is the same in either case, and the amount paid by the insured on top of that-- the MA premium, needs to be compared with the cost of private Medigap plans NOT available directly through the government (but still highly regulated). If you are saying that it costs the government 12% more to administer their Medigap (MA) plan as it does private insurers, it makes sense to turn these folks over completely to private insurers for their supplemental. It will save them the money, and government will save the [high] cost of administering the program. I find it hard to believe, however, that this "saves" the $700 billion supposedly cut from Medicare to "pay for" Obamacare. I remember somebody saying that this money was "counted twice" in the Obamacare budget; maybe this is what they meant, counting both the amount paid out by the private insurers and the amount paid in by the insured.